Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice

Objectives To describe the population with type 2 diabetes mellitus (T2DM) meeting frailty criteria and assess their management based on clinical guidelines (CGL). Patient characteristics, prescribed treatments, adherence to recommendations, and overtreatment prevalence were analyzed. Design Cross-s...

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Autores: Miñana-Castellanos, M, Granés, MR, Camins, BF, Méndez, EN, Puente, JBD, Estella, CL
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Recursos:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p21147
Acesso em linha:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21147
Access Level:acceso abierto
Palavra-chave:Type 2 diabetes mellitus
Frailty
Primary care
Treatment
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spelling Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical PracticeMiñana-Castellanos, MGranés, MRCamins, BFMéndez, ENPuente, JBDEstella, CLType 2 diabetes mellitusFrailtyPrimary careTreatmentObjectives To describe the population with type 2 diabetes mellitus (T2DM) meeting frailty criteria and assess their management based on clinical guidelines (CGL). Patient characteristics, prescribed treatments, adherence to recommendations, and overtreatment prevalence were analyzed. Design Cross-sectional observational study using retrospective data. Setting SIDIAP database (primary care records, Catalonia, Spain). Participants 594,777 T2DM patients; other diabetes types were excluded. Main measures Sociodemographic, clinical, and treatment characteristics were assessed. Frailty was defined using consensus criteria as the presence of one or more major criteria or two or more minor criteria. Major criteria were defined as a Charlson index >4, a Barthel index < 60, weight status alterations, and cognitive impairment. Minor criteria included age >75 years, MEDEA U4 or U5, established cardiovascular disease, and chronic kidney disease. Medications were classified as indicated or not recommended, based on CGL. Not recommended treatments included insulin and sulfonylureas due to their hypoglycemia risk. Glycemic control (HbA1c) and inappropriate treatments in frail patients were examined. Overtreatment was defined as use of not recommended treatments in patients with correct metabolic control (HbA1c < 7%). Results A total of 22.8% of individuals with T2DM met clinical criteria for frailty. Sulfonylureas were the second most frequently prescribed class of glucose-lowering agents after metformin across all groups. Among frail patients, 14% were treated with therapies not recommended by clinical guidelines, primarily insulin (39.4%) and sulfonylureas (29.2%). Overtreatment was observed in over 20% of frail individuals. Conclusions Almost 1 every 4 people with T2DM meet frailty criteria. Low adherence to guidelines and a high prevalence of inappropriate treatments and overtreatment were observed. These findings emphasize the need for increased awareness and better guideline implementation to improve care for this vulnerable population.EDICIONES DOYMA S A2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21147Atencion PrimariaISSN: 02126567ISSNe: 15781275reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Españolinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p211472026-06-14T12:41:47Z
dc.title.none.fl_str_mv Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
title Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
spellingShingle Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
Miñana-Castellanos, M
Type 2 diabetes mellitus
Frailty
Primary care
Treatment
title_short Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
title_full Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
title_fullStr Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
title_full_unstemmed Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
title_sort Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice
dc.creator.none.fl_str_mv Miñana-Castellanos, M
Granés, MR
Camins, BF
Méndez, EN
Puente, JBD
Estella, CL
author Miñana-Castellanos, M
author_facet Miñana-Castellanos, M
Granés, MR
Camins, BF
Méndez, EN
Puente, JBD
Estella, CL
author_role author
author2 Granés, MR
Camins, BF
Méndez, EN
Puente, JBD
Estella, CL
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Type 2 diabetes mellitus
Frailty
Primary care
Treatment
topic Type 2 diabetes mellitus
Frailty
Primary care
Treatment
description Objectives To describe the population with type 2 diabetes mellitus (T2DM) meeting frailty criteria and assess their management based on clinical guidelines (CGL). Patient characteristics, prescribed treatments, adherence to recommendations, and overtreatment prevalence were analyzed. Design Cross-sectional observational study using retrospective data. Setting SIDIAP database (primary care records, Catalonia, Spain). Participants 594,777 T2DM patients; other diabetes types were excluded. Main measures Sociodemographic, clinical, and treatment characteristics were assessed. Frailty was defined using consensus criteria as the presence of one or more major criteria or two or more minor criteria. Major criteria were defined as a Charlson index >4, a Barthel index < 60, weight status alterations, and cognitive impairment. Minor criteria included age >75 years, MEDEA U4 or U5, established cardiovascular disease, and chronic kidney disease. Medications were classified as indicated or not recommended, based on CGL. Not recommended treatments included insulin and sulfonylureas due to their hypoglycemia risk. Glycemic control (HbA1c) and inappropriate treatments in frail patients were examined. Overtreatment was defined as use of not recommended treatments in patients with correct metabolic control (HbA1c < 7%). Results A total of 22.8% of individuals with T2DM met clinical criteria for frailty. Sulfonylureas were the second most frequently prescribed class of glucose-lowering agents after metformin across all groups. Among frail patients, 14% were treated with therapies not recommended by clinical guidelines, primarily insulin (39.4%) and sulfonylureas (29.2%). Overtreatment was observed in over 20% of frail individuals. Conclusions Almost 1 every 4 people with T2DM meet frailty criteria. Low adherence to guidelines and a high prevalence of inappropriate treatments and overtreatment were observed. These findings emphasize the need for increased awareness and better guideline implementation to improve care for this vulnerable population.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21147
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21147
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv EDICIONES DOYMA S A
publisher.none.fl_str_mv EDICIONES DOYMA S A
dc.source.none.fl_str_mv Atencion Primaria
ISSN: 02126567
ISSNe: 15781275
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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